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Severity of trauma experienced by the child, as assessed by a composite of the Child and Adolescent Trauma Screen's child report and caregiver report

Trauma Exposure [ Time Frame: 10 minutes ]

Frequency of exposure of the child to common types of trauma, as assessed by a composite of the Trauma Exposure Screener's child report and caregiver report

Strengths [ Time Frame: 15 minutes ]

Behavioral strengths of the child, as assessed by a composite of the Strengths and Difficulties Questionnaire's child report and caregiver report

Difficulties [ Time Frame: 15 minutes ]

Behavioral difficulties of the child, as assessed by a composite of the Strengths and Difficulties Questionnaire's child report and caregiver report

Functioning [ Time Frame: 5 minutes ]

Level of social functioning of the child, as assessed by a composite of the Child and Adolescent Functioning's child report and caregiver report

Relationship with Caregiver [ Time Frame: 5 minutes ]

Quality of the child's relationship with their caregiver, as assessed by a composite of the Child and Adolescent Social Support Scale (child report) and the Child-Parent Relationship Scale (caregiver report)

Grief [ Time Frame: 20 minutes ]

Level of grief related to a traumatic event experienced by the child, as assessed by the Inventory of Complex Grief

Mental Health [ Time Frame: 5 minutes ]

Level of mental wellbeing of the child, as assessed by the Patient Health Questionnaire (8-question version)

Risk Behavior [ Time Frame: 20 minutes ]

Amount of risk behavior exhibited by the child, as assessed by the Safer Sex Peer Norms and Substance Use Questionnaire

Child Labor [ Time Frame: 5 minutes ]

Amount of labor required of the child in the past week, as assessed by the Child Work and Labor Questionnaire

Social Support [ Time Frame: 10 minutes ]

Amount of social support the child receives, as assessed by the Social Support Services Questionnaire

Orphan Stigma [ Time Frame: 10 minutes ]

Level of stigma experienced by the child as a result of their orphan status, as assessed by the Orphan Stigma and Social Mobility Questionnaire

Exposure to CBT Sessions [ Time Frame: 2 minutes ]

Exposure of the child to their assigned CBT sessions, as assessed by the Child Attendance Log (group leader records this)

TF-CBT Feedback [ Time Frame: 45 minutes ]

Opinions on the TF-CBT program, as assessed by the qualitative Semi-Structured Interview Guide's group leader and site leader reports

Fidelity [ Time Frame: 20 minutes ]

Ability of the group leader to adhere to established TF-CBT protocols and guidelines, as assessed by the Fidelity and Adherence Rating Scales

TF-CBT Knowledge (group leader) [ Time Frame: 25 minutes ]

Test of the level of knowledge of the group leader about TF-CBT, as assessed by the TF-CBT Knowledge Assessment

TF-CBT Knowledge (site leader) [ Time Frame: 2 minutes ]

Test of the level of knowledge of the site leader about TF-CBT, as assessed by the Organizational Questionnaire

Adoption [ Time Frame: 5 minutes ]

Level of uptake of the TF-CBT program by the organization, as assessed by a composite of the Organization Quantitative Questionnaire and the Provider Quantitative Questionnaire

Acceptability [ Time Frame: 5 minutes ]

Level to which the organization values the TF-CBT program, as assessed by a composite of the Organization Quantitative Questionnaire and the Provider Quantitative Questionnaire

Appropriateness [ Time Frame: 10 minutes ]

Level to which the organization sees the TF-CBT program as appropriate for their community, as assessed by a composite of the Organization Quantitative Questionnaire and the Provider Quantitative Questionnaire

Feasibility [ Time Frame: 10 minutes ]

Level to which the organization believes the TF-CBT program can be effectively delivered to their community, as assessed by a composite of the Organization Quantitative Questionnaire and the Provider Quantitative Questionnaire

Reach [ Time Frame: 10 minutes ]

Level of accessibility of the TF-CBT program to members of the community, as assessed by a composite of the Organization Quantitative Questionnaire and the Provider Quantitative Questionnaire

Organizational Climate [ Time Frame: 10 minutes ]

Conduciveness of the organization's climate to delivering the TF-CBT program, as assessed by a composite of the Organization Quantitative Questionnaire and the Provider Quantitative Questionnaire

Implementation Leadership [ Time Frame: 5 minutes ]

Level of ability of the organization's leaders to facilitate the delivery of the TF-CBT program, as assessed by a composite of the Organization Quantitative Questionnaire, the Provider Quantitative Questionnaire, the Group Leader Semi-Structured Interview, and the Site Leader Semi-Structured Interview

General Leadership [ Time Frame: 5 minutes ]

Level of ability of the organization's leaders to manage an effective workplace, as assessed by a composite of the Organization Quantitative Questionnaire and the Provider Quantitative Questionnaire

Sustainability [ Time Frame: 30 minutes ]

Likelihood that the TF-CBT program will continue to be delivered effectively beyond the study period, as assessed by a composite of the Organization Quantitative Questionnaire and the Program Sustainability Assessment Tool

Building and Sustaining Interventions for Children: Task-sharing Mental Health Care in Low-resource Settings

Official Title ICMJE

Building and Sustaining Interventions for Children (BASIC): Task-sharing Mental Health Care in Low-resource Settings

Brief Summary

The study will take place in Kanduyi, a sub-county in southern Kenya, and focuses on children orphaned by one or two parents. Growing evidence demonstrates that orphaned children in low- and middle-income countries are at high risk of post-traumatic stress, but mental health professionals are largely unavailable in this area.

Research suggests that some mental health treatments can be delivered effectively in low- and middle-income countries using a task sharing approach, in which lay counselors with little or no prior mental health experience are trained to provide treatment.

Whetten and Dorsey's past studies have suggested that partnering with two government sectors, education and health, could be a low-cost and sustainable strategy to implement task sharing mental health services. By training teachers (via the education sector) and community health volunteers (via the health sector) to provide mental health care, a larger population could potentially be reached.

Before programs are scaled-up country-wide, it's important to know not only what policies to implement but also their predicted implementation success and intervention effectiveness. This study aims to identify implementation strategies and examine whether the education and/or health sectors are productive partners in scaling up task sharing mental health care in future programs.

Detailed Description

Building and Sustaining Interventions for Children (BASIC): Task-sharing mental health care in low-resource settings builds on our 15-year history of collaborations with research partners in Kenya, prior NIH-funded work that identified mental health needs of orphaned children in low- and middle-income countries, and iterative and collaborative intervention adaptation and testing using a task-sharing approach, to address these needs. In BASIC, the investigator will test the implementation of Trauma-focused Cognitive Behavioral Therapy (TF-CBT), delivered via task-sharing, in two governmental sectors prioritized by our Kenyan partners as potential options for scale up— Education and Health Extension. The recent devolvement of the Kenyan government (leading to more local decision-making), the launch of a National Mental Health Policy, and our Kenyan partners' empowerment work building enthusiasm for TF-CBT are converging to create a local climate in which BASIC could become part of the county plan, if evidence-based guidance for implementation, using mostly existing resources, existed. The investigators test mental health treatment delivery in Education (via teacher delivery) and Health Extension (via community health volunteers) with the goal of identifying implementation practices and policies (IPPs) that explain implementation outcomes. This stepped wedge cluster randomized trial includes 40 schools and the 40 surrounding villages (120 lay counselors in each) who provide TF-CBT to 1,280 youth. The investigators use a novel method, qualitative comparative analyses (QCA), that holds potential for substantially advancing the field of implementation science. QCA leverages the rigor of quantitative approaches and the detail of qualitative approaches, and allows for complex causality and equifinality (i.e., an outcome can be reached by multiple means). Study aims are: 1) Identify actionable IPPs that predict adoption (delivery) and fidelity (high- quality delivery) after 10 sites in sector implement TF-CBT. Use identified IPPs to (Aim 1a) guide implementation planning support for subsequent sites and to (Aim 1b) generate testable hypotheses about IPPs as causal mechanisms; 2) Test mechanisms of implementation success in both sectors; and 3) Test TF-CBT effectiveness (i.e., mental health outcomes; functioning) and cost in both sectors. This research has important implications for implementing an evidence-based treatment in low-resource settings, including the US.

Stepped wedge with 7 steps; Participants are randomized to receive the treatment (therapy sessions) in either a community or school setting

Masking: None (Open Label)Masking Description:

No masking--Participants will be able to tell which arm they belong to based on where they are receiving the treatment (therapy sessions)

Primary Purpose: Treatment

Condition ICMJE

Grief

Post Traumatic Stress Disorder

Depression

Intervention ICMJE

Behavioral: Trauma-Focused Cognitive Behavioral Therapy

Eight small-group sessions, including eight children and one guardian for each child, will meet separately, with joint activities in the final three sessions. TF-CBT will be delivered via community health volunteers in the community setting, and via selected teachers in the school setting--with two lay counselors leading the child group, and one leading the guardian group. Most TF-CBT components (psychoeducation, parenting, relaxation, cognitive coping, grief specific skills) will be delivered in groups, but 2-3 individual sessions mid-group will be used for imaginal exposure (i.e., talking about/processing traumatic events).

Study Arms

Experimental: Community-Based CBT

These participants will receive Trauma-Focused Cognitive Behavioral Therapy in a community setting from community health volunteers

Intervention: Behavioral: Trauma-Focused Cognitive Behavioral Therapy

Experimental: School-Based CBT

These participants will receive Trauma-Focused Cognitive Behavioral Therapy in a school setting from specified teachers

World Health Organization. Beginning with the end in mind: planning pilot projects and other programmatic research for successful scaling up. http://www.who.int/reproductivehealth/publications/strategic_approach/9789241502320/en/. Accessed May 24, 2016.

* Includes publications given by the data provider as well as publications
identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.

Recruitment Information

Recruitment Status ICMJE

Enrolling by invitation

Estimated Enrollment ICMJE (submitted: August 4, 2017)

3072

Original Estimated Enrollment ICMJE

Same as current

Estimated Study Completion Date

January 2022

Estimated Primary Completion Date

January 2022 (Final data collection date for primary outcome measure)

Eligibility Criteria ICMJE

Inclusion Criteria:

Child or young adolescent between the ages of 11 and 14 at the time of enrollment

Child lost one or both parents to death at least 6 months ago or later, and when the child was 4 years old or older

Child lives in the community with at least one adult guardian (18 years old or older)

Child is experiencing borderline or clinically significant levels of post-traumatic stress or childhood traumatic grief (as indicated by a score of 18 or higher on the Child Posttraumatic Stress Scale, or a score of 35 or higher on the Inventory of Complicated Grief)

Exclusion Criteria:

Child has a known developmental or cognitive disability

Child attends private school

Child and family are about to move

Children who lost a parent less than 6 months ago (since they may be experiencing a normal grief reaction and may not necessarily be in need of the treatment for CTG)

Caregiver of the child refuses to participate

Lay counselor is not literate

Lay counselor does not have a mobile phone

Lay counselor refuses to serve as a counselor

Site leader refuses to allow their site to participate in the study

Sex/Gender

Sexes Eligible for Study:

All

Ages

11 Years to 14 Years (Child)

Accepts Healthy Volunteers

No

Contacts ICMJE

Contact information is only displayed when the study is recruiting subjects